The
uninsured
rate has
gone
down.
Since
the
Affordable
Care Act
went
into
effect
in 2014,
Medicaid
has
expanded
130
percent,
allowing
12
million
new
people
to be
covered
in 31
states.

The
first 48
months
of the
Affordable
Care Act
resulted
in a $20
billion
loss to
insurance
companies
as 90
percent
of
participants
received
premium
subsidies
to pay
for
health
insurance
and are
immune
to rate
increases.
However,
10
percent
of
middle-income
earners
receive
no
subsidies,
and the
numbers
insured
in this
category
slid
from 7.5
million
to 4.9
million
as many
dropped
out of
the
program
because
they
couldn’t
afford
the
premiums.

Many
uncertainties
remain
under
the
Affordable
Care
Act. For
example,
on March
25, a
Texas
District
court
struck
down
ACA, and
President
Trump is
seeking
invalidation
of ACA.
However,
with no
replacement,
there
will be
no GOP
regulations
until
after
2020.

Attempts
to allow
for more
choice
may
cause
ACA
rates to
go up
because
programs
such as
association
health
plans,
self-funded
small
employer
MEWAs
and
ministry
plans
will
strip
healthy
people
out from
ACA
coverage.

Other
healthcare
proposals
are
under
consideration:

Medicare
for All
would
result
in a
$150
billion
hospital
revenue
loss,
according
to JAMA,
because
the
government
reimburses
87 cents
for
every $1
of cost
whereas
the
private
sector
pays out
$1.45
for
every
dollar
of cost.

Medicare
for
America
keeps
the
employer
plan
with the
option
of
Medicare.

Medicare-x
choice
is the
current
system,
with the
public
option
for
individual/small
group
and
premium
subsidies
based on
income.

Medicare
at 50:
People
become
eligible
at age
50 with
subsidies
based on
income.

The
site-neutral
payment
policy
cuts
Medicare
outpatient
rates to
match
physician
office
payments,
which
would
result
in a
$610
million
per year
hospital
reduction.

A move
toward
more
home
healthcare,
including
remote
patient
monitoring,
non-skilled
nursing,
home
infusion
and home
dialysis
has
resulted
in
improved
reimbursement
levels
for care
delivered
in the
home via
technology.
Health
outcomes
have
also
gotten
better
as
patients
have
lower
anxiety
levels,
get
better
sleep
and are
not
exposed
to
infection
by
getting
treatment
at home
instead
of in a
hospital.

With
fewer
limitations,
it’s not
necessary
to
always
go to an
emergency
room or
urgent
care
center,
resulting
in lower
costs.
More
mobile
solutions
and
face-to-face
community
programs
are
helping
prevent
serious
problems
such as
hypertension,
back
pain,
depression
and
anxiety.

CMS
continues
to find
preventative
programs
that
have a
high
return
on
capital,
from
adult
daycare
to
carpet
cleaning
and
installation
of air
conditioners
to
prevent
asthma
or
respiratory
issues.

Other
trends
include
bundled
payments
where
healthcare
providers
get paid
based on
health
outcomes;
centers
of
excellence
where a
specialist
performs
the same
procedure
daily;
and
ambulatory/hospital
care
delivered
in
patients’
homes.

Demystifying Population Health
Management and Its Impact on Facilities

Left
to
Right:
Bonnie
Condon,
Vice
President
of
Community
Health
and
Vice
President
of
Faith
Outreach,
Advocate
Aurora
Health

Population health management is about preventing disease by
keeping people healthy. “Eighty percent of what affects us
is outside our body, and is determined by our zip code and
education,” King said. Currently, 97 percent of healthcare
dollars are spent on care after an illness diagnosis.

Many low-income patients must overcome obstacles to receive
adequate healthcare, such as an inability to take time off
work to go to the doctor or a limited ability to get
exercise or buy healthy food because they live in dangerous
areas or food deserts. “Education and zip code are as
important as genetic code,” Condon said.

Advocate Health Care has also launched the Advocate
Workforce Initiative. The program aligns individuals with
entry middle-skill healthcare jobs and serves as a stepping
stone to advance in the workforce.

Stantec Architecture has developed 16 strategies to
implement in its healthcare design with the goal of keeping
people healthy and out of chronically ill conditions. Those
include solving the housing problem, as 50 percent of
chronically ill patients are homeless. Other strategies
focus on securing healthy food options for patients;
providing transportation to the hospital; and ensuring
access to affordable healthcare, mental health and dental,
among others.

In fall 2018, Advocate opened its Trauma Recovery Center to
help victims of domestic violence, hate crime and sexual and
physical assault. It aids people who have experienced trauma
in rebuilding, restoring, and strengthening their sense of
safety by ending the cycle of violence through providing
access to trauma-informed care.

“For victims of violence, we had a golden hour when they
came into the emergency room where we could ask ‘what do you
want to do now?’” said Miiler. Now, with the new center,
Advocate has more opportunity to help victims take care of
essentials like securing a safe place to live and having
food to eat and a place for their children. Then, victims
can work toward overall wellbeing.

Recent examples include the adaptive reuse of former retail
spaces—including a former Sports Authority and a former
Borders Bookstore—into clinics. Modular and prefabricated
spaces are also considered.

Advocate Aurora Health initiated the country’s first master
agreement incentivizes a higher level of team member
integration and collaboration, design innovation between all
team members, a higher level of cost transparency and
increased frequency of reporting and trust amongst the team.
The agreement currently includes 39 partners.

According to the ASHE 2018 Hospital Security Survey,
patient/family violence against staff in the emergency
department has increased 57 percent in the past year, and
attacks/assaults rose 50 percent during that time.

Identifying security needs upfront in construction saves
money later in change orders. For instance, a decision must
be made on the level of public access, from an open campus
to a tight control of entrants that must sign in at a
security desk.

Facility Guidelines documents the need to address safety,
security and access to data early in the design process.
“Reducing the number of nooks and crannies provides more
sight lines so that security cameras can pick up all
activity,” Salahuddin said.

Other panelists offered tips to reduce crime, including
keeping the outside of the building clean and providing
clear signage. “Dirty places attract more crime,” Salahuddin
said. Good lighting and a big monitor where people can see
that they’re on camera also help reduce crime.

Training programs for security officers can increase
confidence. This is especially true of de-escalation
programs, which help guards learn how to deal with people
with dementia or gang ties.

Top security tips:

Select and recruit quality security
personnel.

Implement security education and training
for all employees. Employees need to be trained to not
be casual with passwords.

Establish policies and procedures so
security personnel know how to work on a daily basis.

Make full use of technology and have
cybersecurity protocols in place.

The
internet
of
things
(IoT)
translates
data
into
actionable
intelligence
and
better
business
decisions.
IoT
connects
computers;
captures
critical
data at
every
level,
from
sensor
to
cloud;
converts
data
into
meaningful
analytics;
and
drives
action
through
real-time
information
ad
business
logic.

The
latest
technology
advancements
support
the
increased
focus on
proactive
healthcare
and
prevention.
Healthcare
systems
can now
monitor
patients
remotely
and gain
greater
insight
into a
patient’s
full
health
history.

The
primary
concerns
for
healthcare
providers
include
securing
operational
efficiency
at lower
costs,
decreasing
the
chance
of
adverse
events
that
would
impact
patient
safety
and
improving
the
patient
experience.

Schneider
Electric
manages
cybersecurity
risk,
for
example,
by
making
sure
data is
collected
through
secured
gateways,
establishing
a
secured
data
transport
to
prevent
data
access
or
manipulation,
hosting
client
data in
its
Electric
Data
Center,
displaying
results
(reports,
diagnostics,
etc.) on
a
secured
dashboard,
and
maintaining
the
client
as owner
of their
own
data.

Tips, Tricks
of the
Trade, and
Traps to
Avoid

Door
Security
–
Tom
Morgan,
Assa
Abloy

Look for
Wi-Fi
lock
opportunities
to
provide
access
control
in
locations
where it
would be
difficult
or
cost-prohibitive
to
install
a wired
lock.
With no
wires to
run,
installation
time is
significantly
reduce—simply
install
the
device
on the
door and
configure
it to
communicate
with the
wireless
network.

Door
security
specialists
need to
work
upfront
with
architects
to
provide
the best
possible
products
and
solutions.
“We help
review
all
specification
documents,
ensuring
that
we’re
providing
the
right
applications
and
products
that are
safe,
secure
and
well-designed,”
Morgan
said.

Air
Filtration –
Kyle
Petersen,
Camfil

Be
careful
when
specifying
filters’
MERV
(Minimum
Efficiency
Reporting
Value).
Don’t go
by the
ASHRAE
52.2
standard
Appendix
J test,
because
it could
recommend
lower
filtration
performance.
Instead,
use the
MERV A
test,
which
provides
an
actual
value.

Replace
air
filters
at 2½
times
the
initial
pressure
drop to
maximize
profitability
and
filter
life.

Flooring –
Julie
Stegeman,
nora
systems,
inc.

Subfloor
prep
needs to
be
accounted
for
during
the
design
process,
with
specifications
for the
quantity
of the
compound
material
and
required
subfloor
temperatures
to
maximize
longevity
of the
floor
and
eliminate
problems
from too
much
moisture.

Set
benchmarks
to
ensure
quality
in the
construction
process
and hold
flooring
contractors
accountable
to the
initial
plan.

Large Scale,
Real Time
Savings with
Technology
Breakthroughs
via Modular
and Prefab
Models

Timothy
Swanson, Chief Design
Officer,
Skender

Swanson
mentioned
the
construction
industry’s
documented
productivity
problem,
cited in
the
McKinsey
report
Reinventing
Construction
Through
a
Productivity
Revolution.
The
report
notes
that in
the
U.S.,
construction
ranks
second
to last
in
productivity
gains.
One
solution:
manufacturing-inspired
mass-production,
in which
the bulk
of a
construction
project
is built
from
prefabricated
standardized
components
off-site
in a
factory.
Firms
moving
in this
direction
suggest
that a
productivity
boost of
five to
ten
times is
possible.

Skender
is one
of those
firms.
It has
developed
a
modular
factory
on the
Southwest
Side of
Chicago
to
produce
steel
multi-story
buildings
for
urban
multifamily,
hospitality
and
healthcare
projects.

Modular
construction
can save
money,
time,
energy
and
materials
by
combining
the most
cutting-edge
manufacturing
practices
with
data-driven
technology.
Swanson
noted
that
modular
manufacturing
processes
can
speed up
construction
by 40%
and cut
project
costs by
as much
as 15%.

What’s
Really
Driving
Demand for
More Medical
Facilities
in the U.S.,
Illinois and
Chicago

B. Alan
Whitson, RPA
President,
Corporate
Realty,
Design

&
Management
Institute

From
1999 to
2016,
emergency
room
visits
have
increased
26.4
percent
and
inpatient
admissions
declined
17.7
percent.
Most
dramatic
has been
the huge
increase
in
outpatient
visits—up
91.4
percent
in this
time
period.

Since
1990,
there
are 500
fewer
hospitals
and
100,000
fewer
beds.

With the
shift
toward
outpatient
settings,
the
average
length
of stays
in the
hospital
has also
declined
from an
average
of 7.3
days in
1990
versus
5.5 days
in 2016.

With the
aging of
the Baby
Boomers,
U.S.
doctor
visits
are
slated
to
increase
by 20
percent
by 2030.

There
aren’t
enough
doctors
for the
growing
and
aging
population.
It is
projected
that by
2020,
the
doctor
deficit
will be
65,500
and will
double
to
121,300
by 2030.

Carney
and
Vasileff
are
bullish
on
medical
office
building
investments
because
of the
“silver
tsunami”
and the
shift to
outpatient
care and
value-based
reimbursements.

The
U.S.
population
age
65+
is
projected
to
double
from
2010
to
2040,
according
to
the
U.S.
Census
Bureau.

The
average
65+
person
visits
a
physician
6.6
times
annually
compared
with
3.7
times
for
45-
to
64-year-olds.

Per
capita
outpatient
visits
are
up
25%
since
2000,
while
inpatient
visits
are
down
12%.

Medical
office
buildings
face
significant
supply
constraints—deliveries
are
more
deliberate
than
commercial
office
and
are
system-driven
rather
than
developer-driven.
Health
systems
are
slow-moving,
bureaucratic
decision
makers.
New
deliveries
are
trending
off-campus.

Creating a
Winning
Diversity
Strategy and
Avoiding the
Recent
Struggles